Aesthetic considerations in facial reanimation

The treatment results of facial paralysis have improved within the last two decades with the introduction of new techniques for neuromuscular reconstruction. However, many patients still complain of aesthetic imbalance impairment after treatment. This article presents some complementary procedures that can be used to improve the appearance of the face either isolated in incomplete palsies, or after the completion of reconstructive procedures in complete paralysis. The procedures are divided according to anatomical areas--forehead, eyelids, middle third of the face, and the lower lip.     

Compression only reanimation

Cardiac arrest is the most common cause of death in most industrialized nations. The vast majority of cardiac arrests take place out-of-the hospital making out-of-hospital cardiac arrest (OHCA) a major public health problem. In spite of recurrent updates of national guidelines for cardiopulmonary resuscitation (CPR), in the United States the survival of patients with OHCA due to ventricular fibrillation (VF) averaged 17.7% and was essentially unchanged from the mid-1970s to the mid-2000s. Extensive experiments from basic physiological research laboratories provided a better understanding of not only the difference between primary and secondary cardiac arrest but also of the hemodynamics of resuscitation from primary cardiac arrest. Using these new forms of therapy, we were able to improve survival in our laboratory. These experimental findings failed to result in changes in guidelines as there were no randomized controlled trials in humans. An alternative approach to improving survival in humans is the model commonly used to improve public health problems, that of continuous quality improvement. This process advocates obtaining baseline data, and if not optimal, advocating changes and re-evaluating the results. In the United States as well as in Arizona, the baseline survival rate was 17.7%. We then advocated chest compression only CPR for patients with primary cardiac arrest. The survival rate during the period from the beginning of 2005 to the end of 2009 increased from 17.7 to 33.7%.     

Pre-hospitalization reanimation in cardiac arrest

THE SURVIVAL CHAIN: The delay to restoration of spontaneous circulation is the key to prognosis of cardiac arrest occurring outside the hospital. Among the many etiologies of cardiac arrest, sudden onset ventricular fibrillation is the number one cause of sudden death in adults. Better prognosis depends on effective organisation founded on the concept of a "survival chain". ALERT AND RESUSCITATION: By alerting the emergency units and performing the basic gestures of cardiopulmonary resuscitation (freeing the airways, mouth-to-mouth ventilation and closed chest cardiac massage) those witnessing the event take the first steps in the survival chain while waiting for the paramedical and medical teams to arrive. DEFIBRILLATION: In case of ventricular fibrillation, prognosis is directly related to the delay to defibrillation. Defibrillators used by specially trained paramedics before a physician arrives on the scene have considerably improved prognosis. SPECIALIZED RESUSCITATION: Precise algorithms help guide treatment in accordance with the observed cardiac rhythm. Tracheal intubation and artificial ventilation are fundamental. Among the useful drugs, epinephrine is by far the most important for improving myocardial and cerebral perfusion, improving the chances of recovering spontaneous circulation. The only anti-arrhythmic drug currently used is lidocaine. Infusion of alkaline fluid is only useful in specific cases of prolonged resuscitation. Expired CO2 monitoring may be a useful guide, but discontinuing resuscitation is strictly a medical decision. AFTER RESUSCITATION: When spontaneous circulation has been achieved, the patient must be transported to a cardiac hospital for specialized care and etiological treatment.     

Patient experience ratings in surgery for recurrent hernia

Summary In evidence based medicine it is important to define goals and factors relevant to achieve those goals. The aim of the present study was to investigate patient satisfaction as an endpoint for the quality of groin hernia surgery, and to define factors relevant for this endpoint in patients operated on for recurrent groin hernia. Patient satisfaction questionnaires were mailed to 67 patients operated on for recurrent hernias at Mora hospital between 1995 and 1997, and to a control group of 152 patients operated on for primary inguinal hernias during 1996. The response rate was 88 and 91% respectively. The data revealed that the adequacy of information given to patients as well as the adequacy of analgesics for use at home are both important factors in patient satisfaction. In surgery for recurrent hernia, patients with few years since the operation were more dissatisfied than other patients. Most of our patients, however, thought that the reason for their hernia recurrence was related to themselves. The patients operated on for recurrent hernias showed no difference in overall satisfaction ratings when compared to the control group. However, it is suggested that better information and a better knowledge among patients concerning the reasons for hernia recurrence, will increase patient demands and further emphasis recurrence rate as the important end-point of patient satisfaction in hernia surgery.